Individualized sequencing of targeted immunotherapies in generalized myasthenia gravis across distinct patient profiles
- 1First Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens
Abstract
Background: Targeted immunotherapies have expanded treatment options for acetylcholine receptor antibody-positive generalized myasthenia gravis (gMG), but evidence regarding their sequencing and individualized therapeutic pathways remains limited.
Methods: We describe seven selected adults with AChR-positive gMG managed through individualized targeted-treatment pathways involving administered and, in some cases, planned sequential therapy. Treatment selection was guided by disease severity, corticosteroid-related risks, presence of thymoma, comorbidities, peripheral venous access and the need for rapid clinical improvement and/or sustained disease management.
Results: Across the seven cases, FcRn antagonists were used for rapid symptom control, corticosteroid dose reduction and bridging therapy while the appropriate vaccinations required before planned complement inhibition or B-cell depletion therapy were completed. Rituximab was selected as a long-term B-cell-directed immunosuppressive strategy, particularly in recent-onset gMG. Ravulizumab was planned as a long-term, non-steroidal immunosuppressive therapy in thymoma-associated myasthenia gravis and in chronic gMG with symptoms refractory to conventional non-steroidal immunosuppressive therapy and dependent on corticosteroids.
Conclusion: These seven cases illustrate how targeted immunotherapies may be used sequentially and individualized according to their onset of action, MG subgroup, treatment goal, required vaccinations and route of administration.
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BibTeX
@article{zouvelou2026individualized,
title = {{Individualized sequencing of targeted immunotherapies in generalized myasthenia gravis across distinct patient profiles}},
author = {Vasiliki Zouvelou and Dimitra Tzavella and Eleni Strataki and Aigli G. Vakrakou},
journal = {Frontiers in Neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1989043},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1989043/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Individualized sequencing of targeted immunotherapies in generalized myasthenia gravis across distinct patient profiles
AU - Vasiliki Zouvelou
AU - Dimitra Tzavella
AU - Eleni Strataki
AU - Aigli G. Vakrakou
PY - 2026
DA - 2026/10/16
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1989043
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1989043/full
AB - Background: Targeted immunotherapies have expanded treatment options for acetylcholine receptor antibody-positive generalized myasthenia gravis (gMG), but evidence regarding their sequencing and individualized therapeutic pathways remains limited. Methods: We describe seven selected adults with AChR-positive gMG managed through individualized targeted-treatment pathways involving administered and, in some cases, planned sequential therapy. Treatment selection was guided by disease severity, corticosteroid-related risks, presence of thymoma, comorbidities, peripheral venous access and the need for rapid clinical improvement and/or sustained disease management. Results: Across the seven cases, FcRn antagonists were used for rapid symptom control, corticosteroid dose reduction and bridging therapy while the appropriate vaccinations required before planned complement inhibition or B-cell depletion therapy were completed. Rituximab was selected as a long-term B-cell-directed immunosuppressive strategy, particularly in recent-onset gMG. Ravulizumab was planned as a long-term, non-steroidal immunosuppressive therapy in thymoma-associated myasthenia gravis and in chronic gMG with symptoms refractory to conventional non-steroidal immunosuppressive therapy and dependent on corticosteroids. Conclusion: These seven cases illustrate how targeted immunotherapies may be used sequentially and individualized according to their onset of action, MG subgroup, treatment goal, required vaccinations and route of administration.
SN - 1664-2295
ER -